Clinical Reactions of Disaster and Critical Incident Victims and Responders: Children and Adults

When intervening in any emergency, crisis or critical incident situation, psychological services attempt to facilitate the adaptation process of disaster victims by using:

* A psychological-educative approach

* Emphasizing in all messages that emotional reactions are normal

There are three phases of psychological interventions following a disaster or critical incident:

1. IMMEDIATE ACTION - This includes interventions before, during and immediately following the event. Some examples include:

* Interventions at the disaster site;

* Contact with the clients (home visit if necessary);

* Support to people under stress (stress relief);

* Individual support;

* Setting up of a telephone hotline;

* Participatating in information sessions organized by the municipality;

* Promoting activities where people can discuss the event;

* Preparation of a brochure on normalizing reactions;

* Public notification of the availability of a team from the local * mental health and private practitioner community.

2. TRANSITIONAL MEASURES - These are interventions which take place when people begin to return to their daily lives. Some examples include:

* Support to people under stress;

* Information activities, brochures for different age groups;

* Conferences, workshops, courses;

* Information sessions;

* Activities to promote discussion about the event.

3. PROGRAMS TO ASSIST IN RETURNING TO A NORMAL LIFE - These interventions are those which continue beyond the Transitional Measures stage due to ongoing needs in the community. Some examples include:

* Follow-up home visits;

* Thematic talks to meet identified needs;

* Individual or group consultations;

* Self-help groups;

* Crisis intervention.

There are three client groups that are affected by any incident:

Primary Client Group

People who experienced the event directly. They include the survivors and the people who witnessed the disaster or tragedy.

Secondary Client Group

People who lost a loved one in the disaster or tragedy. They include families in mourning and anyone emotionally close to an immediate victim and those who are affected by the traumatic event.

Tertiary Client Group

The operational staff, the different coordinators and leaders, the people providing psychosocial support and the public.

A major disaster may affect thousands of people from various age groups. Each age group has predominant characteristics. Whenever events occur in a person's life that threaten his or her biological, physical, or social well-being, a certain degree of disequilibrium results. People whose well-being is threatened react with anxiety (Rappoport, 1962). If there is a particularly large number of unpleasant or painful stimuli, the person needs a great capacity for adaptation (Cornell, 1989). In the mental health literature, the stress following a disaster or other tragedy is described as a precise set of symptoms that are manifested following an extraordinary traumatic event (Toubiana, 1988; Mangelsdorff, 1985; Butcher & Hatcher, 1988).


Children's perceptions of a disaster or critical incident seem to be determined by their parents' reactions. Children of preschool age believe that their parents can protect them from all danger. They believe they cannot survive without them. Children of this age fear being injured, lost, or abandoned. This fear increases when they find themselves alone or among strangers.

Adults should be aware that the fertile imagination of preschool children makes them more fearful. Preschool children affected by disasters or critical incidents experience three levels of anxiety:

1. Contagious Anxiety - This type of anxiety is transmitted by adults. It can be dealt with easily in difficult circumstances in a child who is not normally anxious by placing the child in calming surroundings.

2. True or Objective Anxiety - This is related to the capacity of the child to understand the danger that threatens him or her, and the child's tendency to create fantasies based on concrete events. The child is really afraid, because he or she does not know the causes and dangers felt to be threatening. It is useless to try to convince a child that thunder and lightening present no danger if the child does not understand their causes.

One can act on the objective fears of children this age by taking into account their degree of maturity and type of imagination. Adults should help them live through the event and conquer their fears in order to prevent the fears from persisting into adulthood.

3. Profound Anxiety - Different from fear, this involves separation anxiety. The child fears losing those close to him or her. Everything seems dangerous. Fear is omnipresent.

In general, young children express themselves little verbally. It is their behavior that reveals their anxiety and fear.

AGES 6-12

In all cases, the attitude of the family and the environment will have a great influence on the degree of anxiety of the child and on the mechanisms the child will use in the short and long term to cope with stressful situations or events.

The reaction may be immediate or delayed, brief or prolonged, intense or minimal. The child reacts with his or her present personality, at a given level of biological and emotional development. The nature and intensity of the reaction will be determined by the child's temperament as well as past experiences. Faced with the same stressful situation, two children may react in entirely different ways.

The reactions indicate the work of adaptation the child is doing to assimilate, cope with, and "accept" the painful situation.

The reactions most often expressed will translate in various ways the child's anxiety and his or her defenses against it, and will vary with the age of the child: fear, fright, sleep disturbance, nightmares, loss of appetite, aggressiveness, anger, refusal to go to school, behavioral problems, lack of interest in school, inability to concentrate in school or at play. Sometimes the difficulties only occur at school, or they only occur at home, with the child functioning adequately in the school environment.

An anxious child needs security and love above all. The role of the adult consists of helping the child psychologically and trying to understand him or her. Children can be spared much anxiety if we try to imagine their reaction to the event. Seeing through the child's eyes helps the adult to prepare the child emotionally to face events calmly and confidently as they occur.

Reactions can be prevented or lessened by clarifying the situation through open communication about the traumatic event or situation by those close to the child.

AGES 12-17

At this age, the motor skills of young people are often equal to those of adults. It is important for adolescents not to exceed their abilities and to realize that other aspects of their personalities are not as advanced as their physical development. The mental maturity of adolescents has no direct relation to their physical growth. Adults should not let themselves be influenced by appearances and expect an adolescent to have an adult mentality.

Adolescents have a great need to appear competent to the world around them. They struggle to gain independence from their families and are divided between a desire for increased responsibilities and a wish to return to the dependent role of childhood.

At the end of the latency period, young people have generally been able to find a coherent self-definition. Beyond the family and the school, peer groups have a favored place in their concerns and provide them with various means for validating themselves, which they absolutely must do.

A disaster or critical incident can have many repercussions on adolescents, depending on its impact on family, friends, and the environment. They show physical, emotional, cognitive, and behavioral reactions.

Studies have shown that the difficulties experienced by adolescents after a disaster are boredom and loneliness resulting from isolation from their peers because of the disturbance of their activities and the rehousing of their families.

Finally, after a disaster or critical incident, an adolescent may suddenly have to assume an adult role and cope with the need to become the head of the family and provide financial and emotional support to the other members of the family. The adolescent's way of envisioning his or her responsibilities obviously depends on a variety of factors, such as cultural background, age, religious views, education, personal equilibrium, and conception of life.


Elderly people represent their families' memories, their special link with culture and religion. They are autonomous members of the community who are able to define their own needs and ask for the services needed to meet them.

Most elderly people show strength and courage in disasters and critical incidents. Their life experience has enabled them to acquire the ability to recover.

For elderly people, the reactions shown may be a way of expressing their worry about the future and the loss of their physical health, role in the family, social contacts, and financial security.

With age, we observe greater vulnerability in persons who are alone (unmarried, widows and widowers, divorced) as well as extreme sensitivity to emotional losses and socioeconomic and cultural changes.

Without sufficient validation and lacking emotional links with other generations in the community, elderly people become vulnerable to the whole range of physical, psychological and social tensions.


Studies have shown that psychological effects are universally present to some degree in responders involved in a disaster or critical incident situation. Teams of responders on the spot in a disaster or critical incident or after one have psychological reactions that are in every way similar to those of the victims. Several researchers in this area make no distinction between the two groups. Their reactions vary with the magnitude of the event and the number of casualties. It is also important to consider that, in addition to their work with the victims, there are factors of occupational stress: the time factor, overload of responsibilities, physical demands, mental demands, emotional demands, the workplace, environmental factors, limited resources, and the high expectations on the part of the public and the responders themselves. Generally responders function well in spite of the responsibilities, dangers, and stress factors inherent in their work, but sometimes it happens that the intense stress of the event overcomes the defenses they have previously used.

Verbalization sessions after a disaster or critical incident, commonly called ventilation, antistress, psychological recovery, or debriefing sessions, are needed immediately after the event, because the greater the interval between the event and the session, the more chance there is that the responders will develop delayed or lasting reactions.

It is preferable that the professional leading the sessions be someone from outside whose competence is recognized, given the emotionally charged nature of the sessions.

Verbalization sessions on the event should be a service offered to all responders to a disaster or critical incident by their employer.

Whatever the age groups, the psychosocial intervention and activites seek to restore and increase feelings of security, trust and competence, also to promote self-esteem, autonomy self-affirmation and assimilation of the event.

References and Bibliography

Butcher, J.N. and Hatcher, C. (1988). The neglected entity in air disaster planning - Psychological Services. American Psychologist 43(9): 724-729.

Caplan, G. (1964). Principles of Preventive Psychiatry New York. Basic Books Inc.

Cornell, W. Le stress apres un desaster (Stress after a disaster). (January/March 1989). Revue de la protection civile Canada. pp 24-25.

Cuica, R., Dounie, C.S., and Morris, M. (1977). When a disaster happens: How do you meet the emotional needs? American Journal of Nursing 77 (3).

Mitchell, J. and Bray, G. (1990). Emergency Services Stress. Englewood Cliffs, New Jersey. Prentice Hall. 183 pages.

Rappoport, L. (1962). The state of crisis: Some theoretical considerations. Social Service Revue 36, 211-217.

Titchner, J. (October 22-24 1982). Psychological Response to Disaster and Trauma. Expose presente au 3e colloque national sur les facteurs psychosociaux en medecine d'urgence.

Toubiana, Y.H. and Milgram, N.A. (April 1988). Crisis intervention in a school community disaster: Principles and practices. Journal of Community Psychology.

Toubiana, Y.H. (1986). A therapeutic community in a forward Army Field Hospital: Treatment, education, and expectancy in combat stress reaction. In N.A. Milgram (ed.) Stress and Coping in Time of War: Generalizations from the Israeli Experience. Brunner/Mazel.

Mangelsdorff, A.D. (1985). Lessons learned and forgotten: The need for prevention and mental health interventions in disaster preparedness. Journal of Community Psychology.

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